MEDICARE: HANNAH WILHELMSEN CSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	12336890-3502	UT

General Provider Information

NPI Number	:	1740975606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH WILHELMSEN CSW

Provider Business Mailing Address
First Line	:	370 E SOUTH TEMPLE STE 550
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1237
Country	:	US
Telephone Number	:	385-212-4195
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 E SOUTH TEMPLE STE 260
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1290
Country	:	US
Telephone Number	:	385-212-4195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	04/06/2023

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